OBJECTIVETo evaluate the efficacy of the surgery with lateral supraorbital approach for clipping anterior circulation aneurysms.

METHODSThe clinical data of 99 patients with anterior circulation aneurysms who underwent a clipping via lateral supraorbital approach from October 2012 to September 2014 and 75 patients, who underwent a clipping via pterional approach from January 2010 to December 2011 in the second Affiliated Hospital, Zhejiang University School of Medicine were reviewed. The operative duration, prognosis, residual rate and rupture rate during surgery were compared between two groups.

RESULTSThe patients by lateral supraorbital approach had a shorter operative duration, namely 37~61 min less than that in the patients by pterional approach. No difference were found in residual rate and rupture rate between two groups. The Glasgow Outcome Scale (GOS) at 3 months after surgery showed no significant difference between two groups.

CONCLUSIONThe lateral supraorbital approach can be used safely and effectively with shorter operative duration and less tissue damage for treatment of patients with anterior circulation aneurysms.

Aneurysm, Ruptured ; surgery ; Glasgow Outcome Scale ; Humans ; Intracranial Aneurysm ; surgery ; Neurosurgical Procedures ; methods

OBJECTIVETo review the surgical modality with pterional keyhole approach in treatment of anterior circulation aneurysm.

METHODSThree hundred and thirteen patients with ruptured anterior circulation intracranial aneurysm treated surgically with pterional keyhole approach between January 2009 and June 2014 in Department of Neurosurgery, the Second Affiliated Hospital of Zhejiang University School of Medicine, were included in the analysis. Complete occlusion rate of aneurysms and incidence of major complications including delayed cerebral ischemia and chronic hydrocephalus were documented. Surgical outcomes at 6-month follow up were assessed by modified Rankin Scale.

RESULTSTotally 348 aneurysms were treated with pterional keyhole approach, 326 aneurysms were completely clipped, 16 aneurysms were partly clipped, and 6 aneurysms were wrapped with gauze material. Among 313 patients, 15 patients (4.79%) suffered from delayed cerebral ischemia, and 10 patients (3.19%) suffered from hydrocephalus. At the 6-month follow up, the rate of good outcome was 66.77% (209/313).

CONCLUSIONSThe pterional keyhole approach can be used to clip most of anterior circulation aneurysms, and it seems to have advantages over the traditional approaches with lower incidence of complications and similar outcomes.

Aneurysm, Ruptured ; surgery ; Humans ; Intracranial Aneurysm ; surgery ; Neurosurgical Procedures ; methods ; Retrospective Studies ; Treatment Outcome

In recent years, in the absence of venous component, dilated, overlapping, and tortuous arteries forming a mass of arterial loops with a coil-like appearance have been defined as pure arterial malformation (PAM). It is extremely rare, and its etiology and treatment have not yet been fully elucidated. Here, we reported 2 cases of PAM with associated aneurysmal subarachnoid hemorrhage in this paper. Both patients had severe headache as the first symptom. Subarachnoid hemorrhage was found by CT and computed tomography angiography (CTA) and PAM with associated aneurysm was found by digital subtraction angiography (DSA). In view of the distribution of blood and the location of aneurysms, the aneurysm rupture was the most likely to be considered. Based on the involvement of the lesion in the distal blood supply, only the aneurysm was clamped during the operation. It used to be consider that PAM is safety, because of the presentation and natural history of previously reported cases. Through the cases we reported, we have doubted about "the benign natural history" and discussed its treatment. PAM can promote the formation of aneurysms and should be reviewed regularly. The surgical indications for PAM patients with aneurysm formation need to be further clarified. Management of PAM patients with ruptured aneurysm is the same as that of ruptured aneurysm. Whether there are indications needed to treat simple arterial malformations remains to be further elucidated with the multicenter, randomized controlled studies on this disease.
Aneurysm, Ruptured/surgery* ; Angiography, Digital Subtraction ; Cerebral Angiography ; Humans ; Intracranial Aneurysm/surgery* ; Subarachnoid Hemorrhage/etiology*

OBJECTIVETo evaluate the effect of aneurysm clipping and partial blood clot removal in the subarachnoid space on hemorrhage volume in the subarachnoid space and cerebral vasospasm in patients with different Fisher grades.

METHODSPatients with subarachnoid space hemorrhage (SAH) of Fisher Grades I, II, and III were subdivided into control and treatment groups for comparative studies. The patients with unruptured intracranial aneurysms (UIAs) undergoing aneurysm clipping were also compared with Fisher grade I control subgroup. OxyHb levels in the cerebrospinal fluid and cerebral blood flow volume (CBFV) of the middle cerebral artery (MCA) were measured on days 3, 7, and 13 day after SAH.

RESULTSThe patients with UIAs and Fisher Grade I control subgroup showed significant differences in OxyHb levels on day 3 in CBFV of the MCA on days 3 and 7 (P<0.05). In the SAH groups, OxyHb levels increased significantly on day 3 day in the treatment subgroups of Fisher Grades I and II, but declined significantly on days 7 and 13 in Fisher Grade III treatment subgroup as compared with the corresponding control subgroups (P<0.05); in Fisher Grade I group on days 3 and 7 and in Fisher Grade II group on day 7, CBFV of the MCA increased significantly in the treatment subgroups, but in Fisher Grade III group, CBFV decreased significantly on days 7 and 13 compared with the control subgroup (P<0.05). A positive correlation was found between OxyHb levels in the cerebrospinal fluid and CBFV of the MCA (P<0.05).

CONCLUSIONFor patients with Fisher Grades I and II aneurysms, craniotomy may increase hemorrhage volume in the subarachnoid space and exacerbate cerebral vasospasm, but for Grade III patients, aneurysm clipping and blood clot removal shows beneficial effects in terms of reducing hemorrhage volume and relieving cerebral vasospasm.

Aged ; Aneurysm, Ruptured ; surgery ; Female ; Humans ; Intracranial Aneurysm ; surgery ; Male ; Middle Aged ; Subarachnoid Hemorrhage ; cerebrospinal fluid ; surgery ; Vasospasm, Intracranial ; surgery

Aneurysm ; surgery ; Aneurysm, Infected ; surgery ; Aneurysm, Ruptured ; surgery ; Carotid Arteries ; surgery ; Carotid Artery Diseases ; surgery ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures

The rupture of a popliteal artery aneurysm is very rare, and can lead to serious complications if untreated. Any reports of a huge pseudoaneurysm, following rupture of the popliteal artery aneurysm could not be found in a review of the literature. A pulsatile huge mass leading to a deep venous thrombosis, was observed in a 74 years old male patient who for 2 months had had a progressively swollen and painful left leg. On angiographic evaluation, the mass was found to be a pseudoaneurysm originating from a ruptured true aneurysm of the popliteal artery. There was also a small true aneurysm in the contralateral extremity at the same localization. Both the false, and true aneurysms were resected surgically and arterial continuity was established with a synthetic polytetrafluoroethylene graft.
Aged ; Aneurysm/*complications/surgery ; Aneurysm, False/*complications/surgery ; Aneurysm, Ruptured/*complications/surgery ; Blood Vessel Prosthesis ; Human ; Male ; Polytetrafluoroethylene ; *Popliteal Artery/surgery

A 28-year-old female patient was admitted to the Second Affiliated Hospital, Zhejiang University School of Medicine, with sudden headache and vomiting for 1 day. CT scan conducted at emergency revealed subarachnoid hemorrhage, whereas digital subtraction angiography demonstrated a wide-neck aneurysm located at A1 segment of the left anterior cerebral artery. The aneurysm was totally coiled using stent assistance, which, however, was recanalized at 3 month follow-up. This patient was then subjected to aneurysm and parent artery occlusion after bypass of the bilateral A3 segments, who recovered well and discharged without ischemic complications.
Adult ; Anastomosis, Surgical ; Aneurysm, Ruptured ; surgery ; Angiography, Digital Subtraction ; Anterior Cerebral Artery ; surgery ; Female ; Humans ; Intracranial Aneurysm ; surgery ; Recurrence ; Stents ; Subarachnoid Hemorrhage ; surgery ; Tomography, X-Ray Computed

There are debatable claims in the optimal approach for clipping of the anterior communicating artery (AcomA) aneurysm. The authors invented the superior orbital rim approach (SORA) as an alternative and minimally invasive approach for the treatment of AcomA aneurysm. The authors reviewed retrospectively all the medical records of 27 patients of subarachnoid hemorrhage due to ruptured AcomA aneurysm. who were admitted to Kosin University Gospel Hospital for last 2yr. Fourteen women (51.9%) and 13 men (48.1%) were from 29 to 79 yr in age. The mean aneurysm size was 6.2 mm ranging from 4 to 12 mm. A favorable Glasgow outcome scale (GOS) of 4 or 5 was achieved in 92.6%, a GOS score of 3 in 3.7%, and 1 death (GOS 1) occurred in 3.7% of the patients. During the follow-up between 4 and 28 months (mean, 17.5 months) after the surgery, the prognosis of the patients and the cosmetic results were favorable compared with conventional approach. We became to believe that it was an alternative, effective and minimally invasive approach to the surgical treatment of AcomA aneurysm.
Adult ; Aged ; Aneurysm, Ruptured/surgery ; Female ; Glasgow Outcome Scale ; Human ; Intracranial Aneurysm/*surgery ; Male ; Middle Aged ; Neurosurgical Procedures/*methods ; Prognosis ; Retrospective Studies ; Subarachnoid Hemorrhage/surgery ; Treatment Outcome

A recurrent aneurysm at the anastomosis site or the remaining artery frequently occurs after the operative treatment of an aneurysm in Behcet's disease despite anti-inflammatory medication. Herein, a ruptured left renal artery stump aneurysm in a patient with Behcet's disease, who received a left nephrectomy, aorto-biiliac bypass and heterotopic autotransplantation of the right kidney for the treatment of an abdominal aortic aneurysm and renal hypertension one year prior to this admission, is reported. An aneurysm and rupture occurred despite the administration of anti-inflammatory medications while monitoring of the clinical findings, such as skin manifestations, erythrocyte segmentation rate (ESR) and C-reactive protein (CRP). Although there is no definite proven treatment modality to prevent recurrent aneurysms at the anastomosis site or a remote artery, close follow-up with anti-inflammatory medications, and surveillance with regular intervals are the only current methods for the prevention and/or to treatment of an arterial complication in patients with Behcet's disease.
Adult ; Anastomosis, Surgical/*adverse effects ; Aneurysm, Ruptured/*etiology ; Aortic Aneurysm, Abdominal/*surgery ; Behcet Syndrome/*complications/surgery ; Human ; Hypertension, Renal/surgery ; *Kidney Transplantation ; Male ; Recurrence ; *Renal Artery ; Transplantation, Autologous

PURPOSE: Stent-assisted neck remodeling for wide-necked aneurysms requires long-term medication with antiplatelet agents. We describe here a temporary semi-jailing technique (SJT) for wide-necked aneurysms that avoids the need for antiplatelet medications. MATERIALS AND METHODS: Among 101 patients who underwent stent- and/or balloon-assisted embolizations, 3 wide-necked aneurysms, including 1 ruptured aneurysm, underwent the temporary SJT using Enterprise stents. Temporary SJTs were used due to resistance to antiplatelet agents prior to cardiac surgery or to a ruptured aneurysm with a wide neck. The aneurysms were located in the middle cerebral artery, the paraclinoid internal carotid artery segment, and the posterior communicating artery. RESULTS: Enterprise stents were retrieved after coiling without any change in coil mass stability. The final angiogram showed good patency of each parent artery, good stability of the coil mass and total occlusion of the aneurysm. None of the patients experienced any periprocedural or delayed neurological complications. While retrieving the stent from tortuous vessels, we experienced the jumping phenomenon associated with this device. CONCLUSION: Temporary SJTs have the advantage of stent retrieval, thus avoiding inevitable antiplatelet medication. However, care should be taken in tortuous vessels to avoid the jumping phenomenon associated with the device.
Aneurysm ; Aneurysm, Ruptured ; Arteries ; Carotid Artery, Internal ; Humans ; Imidazoles ; Intracranial Aneurysm ; Middle Cerebral Artery ; Neck ; Nitro Compounds ; Parents ; Platelet Aggregation Inhibitors ; Stents ; Thoracic Surgery